急性心肌梗死并发心脏破裂危险因素的病例对照研究  

A Case Control Study for Risk Factors in Patients of Acute Myocardial Infarction Complicated With Cardiac Rupture

作　　者：李龙雨[1] 贾志[2] 梁海青[2] 郭牧[2] 张云强[2] 宋昱[2] 

机构地区：[1]天津医科大学心血管病临床学院,天津市300457 [2]泰达国际心血管病医院

出　　处：《中国循环杂志》2016年第5期442-445,共4页Chinese Circulation Journal

基　　金：滨海新区卫生局科技项目(2014BWK2001)

摘　　要：目的:分析急性心肌梗死并发心脏破裂的临床特点、危险因素,并探究临床防治措施。方法:收集泰达国际心血管病医院收治的有冠状动脉造影资料的急性心肌梗死并发心脏破裂患者44例,为心脏破裂组。在同期急性ST段抬高型心肌梗死(STEAMI)患者中,按1:3匹配原则选择对照组132例。统计两组患者临床资料,采用Logistic回归方法分析具有心脏破裂预测价值的相关危险因素。结果:心脏破裂组β受体阻滞剂使用率明显低于对照组(22.7%vs 84.1%),差异有统计学意义(P<0.05)。单因素Logistic回归分析表明低体重指数、初发心肌梗死、前壁心肌梗死、未行再灌注治疗、再灌注时间延迟、就诊时低血压、心肌梗死后反复胸痛、室壁瘤、高Gensini评分、高水平血肌酐、高B型利钠肽、低射血分数是心脏破裂的危险因素(P均<0.05)。多因素Logistic回归分析表明初发心肌梗死(P<0.049,比值比=7.462)、心肌梗死后反复胸痛(P<0.000,比值比=8.591)、室壁瘤(P<0.005,比值比=4.617)、高Gensini评分(P<0.001,比值比=2.788)是心脏破裂的危险因素。结论:初发心肌梗死、心肌梗死后反复胸痛、室壁瘤、高Gensini评分是STEAMI患者心脏破裂的危险因素。Objective：To analyze clinical characteristics and risk factors in patients with acute myocardial infarction（AMI） complicated with cardiac rupture（CR） and to explore the prevention and treatment strategy in clinical practice.Methods： A case control study was conducted in 2 groups： CR group, the patients with coronary angiography confirmed AMI with CR, n=44 and Control group, the patients with simultaneous STEAMI and by 1：3 pair-matched ratio, n=132. Clinical information was compared between 2 groups and the relevant risk factors for predicting CR were studied by Logistic regression analysis.Results： Compared with Control group, CR group had the lower ratio of β-receptor blocker application（22.7% vs 81.4%）, P〈0.05. Univariate regression analysis indicated that lower body mass index, incipient MI, anterior MI, no-reperfusion therapy, delayed reperfusion therapy, lower blood pressure at admission, post-infarction angina, ventricular aneurysm, higher Gensini score, high blood levels of cretinine and BNP, low ejection fraction were the risk factors for CR occurrence in STEAMI patients, all P〈0.05. Multivariate regression analysis presented that incipient MI（P〈0.049, OR=7.462）, post-infarction angina（P〈0.000, OR=8.591）, ventricular aneurysm（P〈0.005, OR=4.617） and higher Gensini score（P〈0.001, OR=2.788） were risk factors for CR occurrence in STEAMI patients. Conclusion： Incipient MI, post-infarction angina, ventricular aneurysm and higher Gensini score are the risk factors for CR occurrence in STEAMI patients.

关 键 词：心脏破裂 危险因素 1:3病例对照 

分 类 号：R54[医药卫生—心血管疾病]